Effects of different IR laser systems on the tympanic membrane

Lasers suitable for myringotomy are the erbium:YAG laser (2940 nm) and the carbon-dioxide laser (10600 nm). The study examines the laser-tissue interaction with tympanic membranes of guinea-pigs, horses and formalin-fixed human tympanic membranes and the effects demonstrated by light-microscopy and scanning-electron-microscopy. The minimum energy densities for a perforation with the erbium:YAG laser in guinea-pig ear drums and formalin-fixed human tympanic membranes are 8 J/cm² and 16 J/cm² respectively. There are no thermic side effects. With the carbon-dioxide laser thermic side effects only occur with energy transmission via silver halide polycrystalline fiber. The minimum power density for perforation is 400 W/cm² (pulse duration 50 ms). With the microslad 719 micromanipulator (Sharplan, Israel, Tel Aviv), the minimum power densities for perforation of guinea-pig and horse eardrums and for formalin-fixed human tympanic membranes are 150 W/cm ², 300 W/cm² and 600 W/cm² (pulse duration: 50 ms) respectively. The minimum power density to achieve a perforation with the SwiftLase^TM 757 scanner (Sharplan, Israel, Tel Aviv), is 250 W/cm² in guinea-pig eardrums (pulse duration: 100 ms). A prototype of a hand-held carbon-dioxide laser otoscope is suitable for performing laser myringotomies in formalin-fixed human tympanic membranes.